Introduction

Abstract

On 1 December 1846, William Cowen, a 23-year-old stout and healthy-looking groom was admitted into St George’s Hospital, London, having been thrown with great violence from a horse. His right thigh had been lacerated; the wound penetrated the muscles and exposed the bone, leaving the nerves and arteries almost bare. As December passed and the new year of 1847 began, inflammation and infection spread through Cowen’s limb; by the end of January his knee-joint was distended with foul-smelling pus and it was feared that even a physical examination might hasten his death. The surgeons of St George’s — William Cutler, Caesar Hawkins and Thomas Tatum — determined that Cowen’s only chance of recovery lay in amputation and agreed that it should be performed using a new method of pain-relief.